Chemical Terror Threats—Are You Prepared? NYSNA Continuing Education The New York State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This course has been awarded 3.6 contact hours. All ANCC accredited organizations' contact hours are recognized by all other ANCC accredited organizations. Most states with mandatory continuing education requirements recognize the ANCC accreditation/approval system. Questions about the acceptance of ANCC contact hours to meet mandatory regulations should be directed to the professional licensing board within that state. NYSNA has been granted provider status by the Florida State Board of Nursing as a provider of continuing education in nursing (Provider number 50-1437). Chemical Terror Threats - Are You Prepared? 1 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. How to Take This Course Please take a look at the steps below; these will help you to progress through the course material, complete the course examination and receive your certificate of completion. 1. REVIEW THE OBJECTIVES The objectives provide an overview of the entire course and identify what information will be focused on. Objectives are stated in terms of what you, the learner, will know or be able to do upon successful completion of the course. They let you know what you should expect to learn by taking a particular course and can help focus your study. 2. STUDY EACH SECTION IN ORDER Keep your learning "programmed" by reviewing the materials in order. This will help you understand the sections that follow. 3. COMPLETE THE COURSE EXAM After studying the course, click on the "Course Exam" option located on the course navigation toolbar. Answer each question by clicking on the button corresponding to the correct answer. All questions must be answered before the test can be graded; there is only one correct answer per question. You may refer back to the course material by minimizing the course exam window. 4. GRADE THE TEST Next, click on "Submit Test." You will know immediately whether you passed or failed. If you do not successfully complete the exam on the first attempt, you may take the exam again. If you do not pass the exam on your second attempt, you will need to purchase the course again. 5. FILL OUT THE EVALUATION FORM Upon passing the course exam you will be prompted to complete a course evaluation. You will have access to the certificate of completion after you complete the evaluation. At this point, you should print the certificate and keep it for your records. Chemical Terror Threats - Are You Prepared? 2 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. Introduction For Americans, the world changed on September 11, 2001. Our sense of security was shaken. After the terrorist attacks in New York City, Washington and rural Pennsylvania we were further assaulted by the biological attack of anthrax. We wondered at that time, “Where will it all end?” “What will come next?” We found ourselves not entirely prepared for what might lay ahead. Healthcare providers have taken these threats seriously; we have had to educate ourselves about biological, chemical and nuclear threats. Nurses have actively participated learning about these threats; they have been instrumental in emergency planning and treatment in federal and state government emergency preparedness plans. Nurses have signed up for New York State’s Nurse Response Program (http://www.nysna.org/rn_response/nr.htm). Nurses have worked on the local county and facility level to combat these threats. Nurses have volunteered for smallpox vaccination and indeed some of our colleagues have succumbed to the adverse effects of the vaccine. As of July, 2005 no further attacks have occurred, although our threat level has episodically been raised and terrorist attacks have occurred in other locations throughout the world. Despite the current relative calm in relation to terrorism in the US, experts agree that it is not a matter of “if,” but of “when.” This course provides an overview of common chemical weapons that may be used as terror threats, how to recognize a chemical attack, what precautions to take to protect oneself, and how to manage and treat exposures among our patients. Chemical Terror Threats - Are You Prepared? 3 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. Objectives • Identify the categories of chemical agents that can be used as weapons of terror. • Describe select chemical agents in each category. • Discuss decontamination procedures. • Identify how to protect oneself from the possibility of exposure to chemical agents. • Discuss the health effects of select chemical agents. • Describe treatment options for these chemical threats. • Identify where to obtain further resource material on the subject of chemical terrorism. Chemical Terror Threats - Are You Prepared? 4 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. About the Author This course is primarily based on information provided by the Center for Disease Control and Prevention (CDC). Information was accessed from www.cdc.gov; content from the CDC is in the public domain and is not copyrighted. Specific CDC information that was used is listed in the Reference section of this course. Additional references were used in the development of this course and are referenced throughout the course as well as in the Reference section of the course. Chemical Terror Threats - Are You Prepared? 5 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. The History of Chemical Weapon Use While we might consider chemical weapons a product of the industrial and technological ages, they have been used during wartime for centuries. As early as 1000 BC, the Chinese used arsenical smokes against their enemies (Smart, 1997). During the Peloponnesian War in 429 and 424 BC, the Spartans used noxious smoke and flame against the Athenians. During the 30 years war toxic smoke projectiles were used. The British used picric-acid filled shells during the Boer War; the Japanese threw arsenal rag torches into Russian trenches during the Russo-Japanese war (Smart, 1997). Debates about the moral use of chemical weapons during warfare were ongoing throughout the centuries; many proposals for chemical weapons were made, but many governments opposed their use. Military strategists might view chemical warfare agents as simply one of the means to immobilize or destroy an enemy force; others may view such weapons as abhorrent extensions of conventional warfare (Takafuji & Kok, 1997). It was during World War I that chemical weapons were used with regularity. The French used ethyl bromoacetate grenades against the Germans during their invasion of Belgium and France, apparently with little military benefit. In 1914 the Germans used respiratory irritant shells of dianisidine chlorosulfate against the British. Again, there was little military benefit, because when the shell exploded, the explosion destroyed the chemical effect of the weapon. Chlorine, a respiratory agent, was used against the Allies at Ypres, Belgium in 1915, with thousands of troops reportedly killed during the attacks. The Allies retaliated with further chemical agents (Smart, 1997). Throughout WWI, a variety of chemical agents were used, including mustard gas, chlorine, phosgene and cyanide. Nerve agents and vesicants were used by the Iraqi government in the 1980s during the war with Iran; they also used it against their own Kurdish citizens in the town of Halabja in March of 1988. Sarin gas was used by the religious cult, Aum Shinrikyo in 1994 and 1995. During one of these occasions, the gas was used in the Tokyo subway (Smart, 1997). Currently the US military is searching for weapons of mass destruction, including chemical weapons, throughout Iraq. Terrorist attacks, using chemical and other weapons, have increased throughout the world. Since 9/11/01, the US has been forced to deal with multiple threats; learning about chemical weapons and their effects helps healthcare providers to be prepared. Much of what is known about chemical agents is through experience with their use in wartime, manufacturing accidents, accidental releases such as when children find shells while playing and explosions occur, as well as with animal studies. Chemical Terror Threats - Are You Prepared? 6 © 2003, 2005 NYSNA, all rights reserved. Material may not be reproduced without written permission. Readiness for the Possibility of Chemical Threats While government agencies work toward the elimination of chemical terrorist threats, “being prepared” for healthcare providers, must focus on the health management of these threats. This requires gaining knowledge and competence in the recognition and treatment of chemical exposures, while safeguarding one’s own health. The Centers for Disease Control and Prevention (CDC) has developed Emergency Preparedness Competencies for all Public Health Workers. While many in healthcare do not work in the public health field, these competencies have some application to other healthcare arenas. Included in the competencies is the ability to: • Describe the agency chain of command in an emergency response; • Identify and locate the agency emergency response plan, or in large agencies, the pertinent portion of the plan;